本文選題：子宮內(nèi)膜異位癥 + 不孕　； 參考：《浙江大學(xué)》2015年碩士論文

【摘要】：目的 探究子宮內(nèi)膜異位癥合并不孕患者行腹腔鏡治療術(shù)后影響妊娠的因素及其預(yù)測術(shù)后妊娠結(jié)局的價值,為臨床治療提供科學(xué)依據(jù)。 方法 收集、整理、隨訪本院2011年4月至2013年12月行腹腔鏡手術(shù)治療的子宮內(nèi)膜異位癥(EMT)合并不孕患者的病史、手術(shù)資料、手術(shù)后治療情況及妊娠結(jié)局。回顧性分析患者的年齡、r-AFS分期,EFI評分、竇卵泡數(shù)、術(shù)后GnRH-a治療與否、術(shù)后ART治療與否等因素與EMT合并不孕患者術(shù)后妊娠的關(guān)系。采用SPSS19.0統(tǒng)計軟件數(shù)據(jù)包進行分析。 結(jié)果 1.2011年4月至2013年12月共489例患者接受手術(shù),失訪57例,隨訪到病例432例。術(shù)后隨訪12-36個月。術(shù)后成功妊娠290例(其中自然妊娠143例,IVF妊娠138例,人工授精妊娠9例),總?cè)焉锫蕿?7.1%,自然妊娠率為40.4%。 2.將所有病例分為妊娠組和非妊娠組,COX單因素分析提示：兩組年齡、不孕時間、EFI評分、術(shù)后竇卵泡數(shù)、合并腺肌癥、術(shù)后應(yīng)用ART治療有統(tǒng)計學(xué)差異(P0.1)。COX多因素分析提示：EFI評分、術(shù)后AFC、術(shù)后ART治療為妊娠的保護性因素,合并腺肌癥為危險因素。 3.EFI評分與累積總?cè)焉锫史治?曲線下面積為0.662,臨床截斷值為7分,敏感度為0.717,特異性為0.518。EFI評分與累積自然妊娠率分析,曲線下面積為0.638,臨床截斷值為7分,敏感度為0.783,特異度為0.401。隨著EFI評分的升高,累積總?cè)焉锫始白匀蝗焉锫示@著升高。 4.當(dāng)EFI評分≤5分時,輔助生育技術(shù)的應(yīng)用可以顯著提高術(shù)后的累積總?cè)焉锫?縮短妊娠的時間。 5.術(shù)后竇卵泡數(shù)(AFC)與總?cè)焉锫史治?曲線下面積為0.662,臨床截斷值為9個,敏感度為0.543,特異性為0.735。在合并巧囊型病例中,曲線下面積為0.694,臨床截斷值為9個,敏感度為0.439,特異性為0.908。隨著術(shù)后AFC數(shù)量的增多,累積總?cè)焉锫曙@著升高。 結(jié)論 1.EFI評分、術(shù)后AFC、合并腺肌癥、術(shù)后ART治療與否與EMT合并不孕患者的術(shù)后妊娠結(jié)局密切相關(guān)。 2.行腹腔鏡治療手術(shù)一定程度上可以改善EMT合并不孕患者術(shù)后的妊娠結(jié)局。 3.采用EFI評分及竇卵泡計數(shù)可有效預(yù)測EMT合并不孕患者腹腔鏡治療術(shù)后妊娠結(jié)局,臨床截斷值分別為7分和9個。EFI評分≤5分時輔助生殖技術(shù)的應(yīng)用可以改善妊娠結(jié)局,縮短妊娠時間。
[Abstract]:Purpose To explore the influencing factors of pregnancy and the value of predicting the outcome of pregnancy in patients with endometriosis complicated with infertility after laparoscopic treatment, and to provide scientific basis for clinical treatment. Method To collect, organize and follow up the history, surgical data, post-operative treatment and pregnancy outcome of patients with endometriosis associated with infertility who underwent laparoscopic surgery from April 2011 to December 2013. The relationship between age, r-AFS stage, antral follicle number, GnRH-a treatment after operation, ART treatment after operation and pregnancy after EMT combined with infertility were analyzed retrospectively. The data package is analyzed by SPSS19.0 statistical software. Result 1. From April 2011 to December 2013, a total of 489 patients were operated on, 57 cases were lost and 432 cases were followed up. Postoperative follow-up was 12-36 months. There were 290 cases of successful pregnancy (143 cases of natural pregnancy, 138 cases of IVF pregnancy, 9 cases of artificial insemination pregnancy). The total pregnancy rate was 67.1%, and the natural pregnancy rate was 40.4%. 2. All the cases were divided into pregnancy group and non-pregnancy group by Cox single factor analysis. The results showed that age, time of infertility, number of antral follicles after operation, and adenomyosis after operation were significantly different between the two groups. The multivariate analysis of ART showed that there was a significant difference between the two groups in terms of age, time of infertility, number of antral follicles and adenomyosis. Postoperative ART therapy was the protective factor of pregnancy, and adenomyosis was the risk factor. 3.EFI score and cumulative total pregnancy rate analysis showed that the area under the curve was 0.662, the clinical truncation value was 7 points, the sensitivity was 0.717, the specificity was 0.518.EFI score and cumulative natural pregnancy rate analysis, the area under the curve was 0.638, and the clinical truncation value was 7 points. The sensitivity and specificity were 0.783 and 0.401 respectively. With the increase of EFI score, the cumulative total pregnancy rate and the natural pregnancy rate increased significantly. 4. When the EFI score is 鈮，

本文編號：1863630